Dr. Dana Johnson: Language Development

Dear Dr. Johnson: My 18 month old doesn’t seem to be talking as much or as clearly as other kids her age. Should I be concerned?

Dear Reader: Language delay occurs in one out of every five children and is the most common developmental delay. While using peers as a guide for developmental milestones can sometimes be helpful, it is not always the best measuring stick.

Especially between the age of 12 and 24 months, there is a wide variation in normal language development. Some 18 month olds have several individual words they use regularly and others are speaking in complete sentences. Both can be normal development. The most important aspect is that a child is developing new words and showing gains in communication skills.

Language development can be divided into three components:

1. Speech. This is marked by the ability to produce sound.

2. Expressive. Can be verbal or nonverbal ways of communicating ideas, desires and feelings.

3. Receptive. This means the ability to understand what is heard and seen.

Some children may show delays in just one area, while others may have delays in multiple areas.

The first step in evaluating your child would be to determine if she is delayed for her age. I recommend talking with her doctor to help you determine this. They may use age-based questionnaires to assess this and other areas of development, including fine motor, gross motor, personal-social and problem-solving.

If you or the physician have concerns after this evaluation, a more detailed evaluation can be completed by a speech therapist or through the federally mandated Birth to 3 Program.

A speech therapy evaluation may be covered by insurance, but subsequent session numbers may be limited as far as coverage is concerned. The Birth to 3 Program (Part C of the Individuals with Disabilities Education Act) supports families of children with delays or disabilities under the age of 3. Starting at age 3, evaluations can be done through the local school system even before a child enters school.

With the Birth to 3 Program, the initial evaluation is free. Anyone with concerns about a child’s development can refer them to Birth to 3 for an evaluation.

I believe one of the biggest advantages of the program is that the evaluation and services are offered in the child’s home. This allows the child to be in their natural environment to facilitate accurate evaluation of skills and optimization of learning.

To meet eligibility for Birth to 3 services, there needs to be a developmental delay of at least 25 percent in one area of development, a physician-diagnosed condition with a high probability of developmental delay, or an atypical (unusual) development that adversely affects the child’s overall development.

In Wisconsin, we have a Parental Cost Share System in which parents who are determined to be financially able will share in the cost of early intervention services for their child.